Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle - a 17 years observational cohort study

Inversion injury to the ankle and hamstring injuries are common problems in most sports. It is not known whether these injuries constitute a predisposing factor or a precursor of injury or re-injury of these anatomical locations. Therefore, we wished to test the hypothesis that a previous inversion ankle injury exerted a significant effect on the chance of an athlete suffering from a subsequent ipsilateral hamstring injury and vice versa. In an observational cohort study over 17 years (1998-2015), 367 elite track and field athletes, were grouped according to their first traumatic isolated ankle or hamstring injury. Fifty athletes experienced both injuries. The Mann-Whitney U and Chi-square tests (p < 0.05) were performed to test possible associations of ankle and hamstring injury with age, gender, athletics discipline, grade, and type of antecedent injury. Athletes with a preceding ankle injury had a statistically significantly higher chance of experiencing a subsequent hamstring injury compared with athletes who had experienced a hamstring injury as their first traumatic event (x 2 = 4.245, p = 0.039). The proportion of both ankle and hamstring injury events was not statistically different between female (18%) and male (11%) athletes. Age and grade of injury did not influence the proportion of ankle and/or hamstring injury events. There is a statistically significantly higher frequency of hamstring injuries in elite track and field athletes having experienced a previous ankle ligament injury

Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains

Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the validity of supersonic SW elastography against a gold standard method to measure the Achilles tendon’s in vivo tensile stiffness by combining conventional ultrasound imaging with dynamometry. Twelve healthy participants performed maximal voluntary isometric plantarflexion contractions (MVC) on a dynamometer with simultaneous ultrasonographic recording of the medial gastrocnemius musculotendinous junction for dynamometry-based measurement of stiffness. The tendon’s force-elongation relationship and stress-strain behaviour were assessed. Tendon stiffness at different levels of tension was calculated as the slope of the stress-strain graph. SW speed was measured at the midportion of the free tendon and tendon Young’s modulus was estimated. A correlation analysis between the two techniques revealed a statistically significant correlation for small strains (r(10)=0.604, p=.038). SW-based assessments of in vivo tendon stiffness were not correlated to the gold standard method for strains in the tendon greater than 10% of the maximum strain during MVC. The absolute values of SW-based Young’s modulus estimations were approximately three orders of magnitude lower than dynamometry-based measurements. Supersonic SW elastography should be only used to assess SW speed for the detection and study of differences between tissue regions, differences between people or groups of people or changes over time in tendon initial stiffness (i.e., stiffness for small strains)

What are patients’ knowledge, expectation and experience of radial extracorporeal shockwave therapy for the treatment of their tendinopathies? A qualitative study

Abstract Background Extracorporeal shockwave therapy (ESWT) is used to manage different tendinopathies and appears to be effective in some tendinopathies but not others. The reasons for this are unclear. There is evidence that patient outcomes can be influenced by a patient-centred approach. There is therefore a need to qualitatively evaluate patient experiences for a treatment like ESWT where uncertainties exist. The aim of this study was to understand patients’ overall perspective of ESWT to manage their tendinopathy. Methods A qualitative semi-structured face-to-face interview study design was used and the data was analysed thematically using ‘Framework Analysis’. Results Eleven participants that have had radial ESWT (rESWT) to treat a range of tendinopathies were recruited from a private London sports clinic and interviewed in person or via Skype™. Four main themes and 16 subthemes were identified. Subthemes included previous failed treatment, clinician factors, mechanisms of ESWT, positive aspects, negative aspects, responsibility over own health and perceived outcomes. Conclusion The participants understood the procedural aspects of rESWT, but were largely unaware of its mechanism of action and whether it was found to be effective for their condition or not. The participants felt that self-management measures were equally or more important than rESWT to help treat their tendinopathies. Recommendations would be for rESWT providers to offer patients written information, maintain continuity of care, address patients’ expectations, feedback on progress, and encourage self-management measures such as activity modification

Plantar pressure of clipless and toe-clipped pedals in cyclists - A pilot study

To determine the effect of clipless and toe-clipped pedals on plantar foot pressure while cycling. Seven bikers and 11 healthy volunteers were tested on a Giant ATX Team mountain bike, Tekscan Clinical 5.24 F-scan® system with an inner sole pressure sensor, a Tacx Cycle force One Turbo Trainer and a Cateye Mity 8 computerized speedometer were used. The subjects wore Shimano M037 shoes and used a standard clipless and toe-clipped pedal. The seat height was set at 100% of subject’s trochanteric height. Plantar pressures were recorded over 12 consecutive crank cycles at a constant speed for each of the power outputs. The videos were analysed to record the pressure exerted at 12 positions on the foot for each variable. Whether there is any dominance of any of the metatarsals, and any difference in plantar pressures between clipped and clipless pedal. There was a significant difference in the pressure at many positions of the foot, but the sites were different for each individual. General regression analysis indicated that pedal type had a statistically significant effect on plantar pressure at the sites of 1st metatarsal (p=0.042), 3rd metatarsal (p<0.001), 5th metatarsal (<0.001), 2nd (p=0.018) and 5th toe (p<0.001), lateral midfoot (p<0.001) and central heel (p<0.001) areas. Clipless pedals produce higher pressures which are more spread across the foot than toe-clipped pedals. This may have implications for their use in the prevention and/or management of overuse injuries in the knee and foot

Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties

Abstract Background Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies. Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology. Results Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded. Conclusions A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness

Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia

Symptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport

Additional file 1: of What are patients’ knowledge, expectation and experience of radial extracorporeal shockwave therapy for the treatment of their tendinopathies? A qualitative study

Table S1. Data charting within the analytical framework. (DOCX 28 kb

Diagnosis and management of Achilles tendon ailments: the Scottish mist

Abstract The diagnosis and management of Achilles tendon ailments continue to be widely discussed by the scientific community. Also, the nomenclature used to describe the tendinopathic lesion in patients changed over the last decades together with the evolution in the knowledge of the physiopathology of Achilles tendinopathy, and unfortunately, through ignorance and possibly laziness, confusion still abounds. To emerge from these foggy paths, some clarifications are still necessary. The present Editorial tries to clarify some of these issues

Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study

Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman’s rho correlation (r=0.462, p<0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis

Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries

ObjectiveTibial stress injuries are challenging in terms of early diagnosis, management strategy, and safe return-to-play. In the present study, pain production associated with the application of therapeutic ultrasound (TUS) was used as a primary diagnostic tool to assess tibial bone stress injuries, and the sensitivity of this procedure was compared with Magnetic Resonance Imaging (MRI).Subject and methodsThe study was designed as a retrospective analysis of prospectively collected data on tibial bone stress injuries in elite Track and field athletes attending the National Track and Field Athletics Centre in Thessaloniki, Greece, in the period 1995–2007. All patients underwent evaluation by TUS, and the sensitivity of the procedure was compared with MRI.ResultsFour of 29 athletes showed a positive TUS examination for stress injury while MRI showed normal findings. Additionally, 5 athletes evidenced MRI findings typical of a tibial bone stress injury, while TUS evaluation was negative. Using MRI as the standard, TUS displayed a sensitivity of 79.2%.ConclusionTherapeutic ultrasound is a reproducible modality with satisfactory reliability and sensitivity related to MRI, and could represent a useful tool for clinicians to primarily assess suspected tibial bone stress injuries in high qualification Track and Field athletes